On a monthly basis, we run a Q&A with a nurse in a particular job in the nursing field. This month, we interviewed Faith Lynch, MSN, RN, CNN (Certified Nephrology Nurse), Nurse Manager, Acute Dialysis at NYU Langone Hospital—Long Island.
What follows is our interview about working as a nephrology nurse. It’s edited for length and clarity.
DN: How did you get interested in being a nephrology nurse? What drew you to it? How long have you been doing it?
I have been in nephrology nursing for 15 years in multiple areas: chronic dialysis, acute dialysis, and I dabble in home hemodialysis. Chronic dialysis was the first job I was offered coming out of nursing school. I have to be honest and say that I was not sure I would like it. I thought it would be boring.
Little did I know how wrong I was! It is fast-paced, and I get to critically think on a daily basis– it is very much like a mini emergency room. I did not realize how much I would end up falling in love with it!
I have remained in the nephrology/dialysis space and moved over to the acute dialysis side seven years ago, as I wanted to gain experience with the more critical care aspect of the patient population. I think when you love what you do and the population you serve, you feel vested in trying to make it better.
DN: What does a nephrology nurse do?
A nephrology nurse takes care of and provides patients that have end-stage kidney disease (ESKD) or acute kidney injury (AKI) with some type of renal replacement therapy (hemodialysis, peritoneal dialysis, continuous kidney replacement therapy). This population of patients has poor kidney function and dialysis acts as an artificial kidney. It removes and filters toxins/wastes/ and fluids from the bloodstream. Many patients will need dialysis for life unless they get a transplant or have kidney function recovery.
Nephrology nurses are unique in that we are the only ones that independently carry out a potentially hemodynamically destabilizing procedure (hemodialysis) most frequently without a physician present. All other invasive procedures are done by a physician, not a nurse. Nephrology nurses can look at a patient and know their hemodynamic status; it is a skill that not all nurses possess.
DN: Did you need to get additional education for this position?
Nephrology nurses can have all different types of nursing degrees and education. You can be a Licensed Practical Nurse (LPN) or a Registered Nurse (RN), but scope of practice differs with each degree. Most nurses without nephrology/dialysis experience go through a very vigorous orientation. Mine lasted 12 weeks. I had to learn everything from the ground up about kidneys, structure and function, the disease process, the stages of kidney disease, how it’s treated, how the machine works and functions, and the complications that could occur–before I even learned how to perform the procedure on a patient.
It takes at least six months for a nurse to feel comfortable performing dialysis, as it comes with many intradialytic complications that you learn how to handle over time. Many nephrology nurses will go on to get their certification as either a Certified Nephrology Nurse (CNN) or a Certified Dialysis Nurse (CDN), which is a certification exam administered by the Nephrology Nursing Certification Commission (NNCC). This certification demonstrates excellence and knowledge when it comes to patient safety and quality.
DN: What do you like most about working as a nephrology nurse?
Nephrology nursing is a large umbrella term for many different areas. That is what I like most about it. You can stay within the “nephrology” area, but do many different things. You can work in hemodialysis, peritoneal dialysis, education, leadership, home dialysis, transplant, pediatrics, advanced practice, office, hospital, clinic… the areas are endless.
But what I love most about dialysis is the relationships. The relationships you develop with patients is unique. You are caring for them at least four hours at a time, three times a week. You are with these patients more than you are with your family, so these patients become your family.
DN: What are your biggest challenges as a nephrology nurse?
Learning to deal with so many different personalities. Many nurses will say that dialysis patients are the most difficult patient populations to deal with; they go through many stages of grief with this disease process. You learn to grow thick skin as time goes on and to not take everything so personally.
DN: What are your greatest rewards as one?
Watching the profession and specialty advance. There is so much innovation coming. A few weeks ago, my team and I were able to get the first patient from the hospital directly to home on hemodialysis. This patient came into the hospital, started dialysis, and never needed the chronic dialysis unit for training. Training started in the hospital and continued at home. He was dialyzing himself in seven days on his own! It was a difficult feat to get everything done logistically, but we did it. That’s part of innovation.
Another reward is being part of the American Nephrology Nurses Association (ANNA). They give their members so many opportunities for professional growth and that is meaningful. I have made so many friends and have networked with so many people through ANNA. They are a nursing organization that is driven by what their members want and need.
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